Determining costs to define value in medical education

Medical education is notoriously expensive, but even medical school administrators and faculty often don’t know its total cost to their institutions. Some estimates put the cost, per student, of delivering medical education at two or even three times the tuition charged. A new project at the University of Utah School of Medicine (UUSOM) is evaluating the spectrum of the school’s teaching activities to determine their true costs and define the best values in undergraduate medical education (UME) methods.

The project, called “Bending the Cost Curve: Developing a Metric to Optimize the Value of Undergraduate Medical Education,” grew out of similar work at the university’s Health Sciences Center, to determine the costs of clinical care.

The clinical care effort aggregated data and organized it into professional and facilities costs. This enabled decision makers to drill down to the costs of specific procedures in increments, such as one minute in the operating room, and allowed for standardization of care that lowered costs while also improving patient outcomes.

“We thought, ‘That’s lovely. Couldn’t we do the same thing with education?’” said Sara Lamb, MD, associate dean for education, curriculum, at UUSOM. “Medical schools do things lots of different ways, but we’re all aiming toward producing the same thing—really good graduates—so why are we all doing things so disparately? And aren’t there things we could learn from each other if we knew what we spent and what actually has the highest impact?”

Need for better data, new definitions

Medical students are being asked to master an ever-expanding core of scientific content and simultaneously develop competency in interprofessional practice, quality improvement, patient safety and health systems navigation and integration.

Determining where faculty time, in particular, is required in each of these curriculum areas is crucial to making choices among team-based learning, problem-based learning and case-based learning models. According to Dr. Lamb, professional costs can be many times facilities costs.

But, Dr. Lamb said, there is a gap in the literature on defining UME’s value. This led her team to develop its own formula for value: V = (Q+E)/C, wherein the value (V) of the UME program is derived from the sum of the quality (Q) of the graduates produced by the program and the experiences (E) of the students and faculty delivering the program, divided by the cost (C) required to administer the program.

Project objectives and outcomes

“Bending the Cost Curve,” which is partially funded by a grant from the AMA as part of its Accelerating Change in Medical Education initiative, is a three-year project with these core objectives:

Identify the real cost of each component of the UME program at UUSOM

Collaborate with other consortium schools to define what constitutes the highest quality UME programs

With the project nearing the end of its first year, Dr. Lamb and her colleagues have almost completed calculating the UUSOM’s facilities costs and are working through its professional costs.

The school’s faculty and administrators are eager to see the data.

“They’re very excited to know that we’re actually giving some thought to what works and what things cost,” Dr. Lamb said. “For a long time, we have been making incremental improvements to the curriculum, but they’ve required a lot of faculty time.”

Students are interested in the numbers too.

“I’m quite excited about what their responses will be once we get the data back, because our students have the tendency to believe that they are paying an outrageous amount of money for their medical education,” Dr. Lamb explained. “I don’t think they know how much the institution contributes to what it costs to educate them.”

Coordinating to accelerate change in medical education

Longer term, Dr. Lamb and her colleagues aim to create a strategic plan to improve the value of UME training and reduce the cost to train medical students, as well as to develop a high-quality, high-value pilot UME program at UUSOM.

UUSOM is one of 32 medical schools in the Accelerating Change in Medical Education Consortium. Its project is unique among the schools, although it complements efforts at the University of Chicago Pritzker School of Medicine, Eastern Virginia Medical School and Rutgers Robert Wood Johnson Medical School that are piloting high-value, cost-conscious care projects.

“The best part of being in this consortium is we have relatively ready access to these 32 other schools,” Dr. Lamb said. “And we can help everyone answer some very important questions, such as: What really works? What does it cost? Is it something other institutions can replicate? And is it worthwhile for them to invest in?”

UUSOM’s intent is to share its findings on a broad scale, beginning with the 32 consortium schools and in peer-reviewed journals.

“The beauty is that there are a lot of schools that are doing a lot of interesting things,” Dr. Lamb said. “We may not know their long-term outcomes just yet, but we can gather data from the group and start to make some determinations about the value of their work. We think this is the beginning of a new operating model for medical education.”